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A Request for Standardization of Publishing of Blood Culture Processing Interventions Reply
Eby, J. C., Mathers, A. J., Cox, H. L., Richey, M. M., Platts-Mills, J. A., & Novicoff, W. M. (2018). A Request for Standardization of Publishing of Blood Culture Processing Interventions Reply. Clinical Infectious Diseases, 66(9), 1485-1485. https://doi.org/10.1093/cid/cix1017
To The Editor—We appreciate the insightful comments by Weinbren and Collins regarding the effect of blood culture processing on the clinical impact of new diagnostic technologies and are happy that our article [1] would stimulate this discussion. In our report, rapid diagnostic testing (RDT) for Staphylococcus aureus bacteremia was implemented in conjunction with a novel process for efficient mandatory infectious diseases (ID) consultation. For this quality improvement project, our group intervened upon the process of S. aureus management starting with Gram stain positivity and ending with ID consultation because we had identified correctable inefficiency and variability in these components of care. The resulting improvements in time from Gram stain to targeted antibiotic, and time from Gram stain to ID consultation are reported in the article. Although we chose not to focus on the aspects of management preceding Gram stain positivity, these aspects of care are, as Weinbren and Collins point out, also very important for improving patient care. Time from culture collection to intake in the microbiology laboratory (transport), and time from intake to loading into the incubator (processing) are monitored at the University of Virginia microbiology laboratory. Over 2 full academic years 2015 to 2017, data from 46,470 blood cultures were recorded, showing median transport time of 0.27 hours (interquartile range 0.13 to 0.52 hours) and median processing time of 0.27 hours (interquartile range 0.17 to 0.43 hours). Time from blood culture bottle positivity to Gram stain (unload time) is not routinely recorded in our microbiology laboratory, but the laboratory is staffed for proficient blood culture management 24 hours per day, 7 days per week, and unload times of >30 minutes are rare. We could speculate that, if we experienced in our microbiology laboratory, the load and unload times described by Weinbren and Collins, temporal gains in patient management enabled by RDT may have been reduced, and our interventions may not have had the same impact on patient outcomes. Each institution must decide within their context of care and resources which steps in a process are most clinically impactful, time consuming, variable, correctible, and cost-efficient when planning improvements. We believe that efficient integration of laboratory and clinical flow will ultimately improve patient care and satisfaction.